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October 21, 2023

Reflections on the Senate Hearing on the NIH Director Nomination

Earlier today, the Senate HELP Committee at long last held a hearing on the nomination of Monica Bertagnolli to be the new NIH Director (C-SPAN here). What we saw throughout the hearing is a microcosm of why multiple NIH directors have said that the agency is pulled in too many directions to be able to have a coherent approach on macro issues, such as:

  • NIH’s overall structure and organization (e.g., why do we have these particular 27 Institutes and Centers?),
  • NIH’s overall strategy,
  • NIH’s prioritization for different areas of science and health,
  • How best to support outside-the-box research, or
  • How best to support younger investigators so that the median age of a first major grant is closer to 30 than to one’s mid-40s.

With rare exceptions (such as Susan Collins asking how Bertagnolli would prioritize cancer versus other diseases), the Senate hearing didn’t tackle macro issues like the above.

Instead, for the most part, the hearing went to the opposite extreme. Within a fairly short time period, Bertagnolli was asked to commit to doing more as to basically everything under the sun — pediatric cancer, medication-assisted treatment for opioid use, funding more rural and Midwestern institutions, clinical trials for ALS, menopause research, antibiotic resistance, infectious diseases like tuberculosis, long COVID, lowering drug pricing (or, from another Senator, not doing anything to lower drug prices), ethics review of fetal tissue research, screen time for children, potential pandemic pathogens, and more. 

Obviously any given NIH budget is a zero-sum game, and it is near-impossible for anyone to increase NIH’s focus on so many different issues at once—not even the NIH Director (who has less authority to unilaterally determine overall NIH policy than some Senators seemed to think).

But beyond that, the Senators were largely focused on one-off issues, not on big-picture issues such as NIH’s overall organization, or whether to use more experimentation in funding processes, etc. The hearing was almost entirely a laundry list of personal concerns based on each Senator’s constituency, family members, or interest groups. 

If we want academic biomedical scientists to do the best science they can, it’s probably better if NIH is able to have a coherent structure, agenda, and budget that isn’t being yanked in different directions based on whether Alzheimer’s is more popular than cancer this year (or vice versa). The Senate should be far more worried about structural issues like how best to recruit top-notch early-career investigators who don’t want to wait until they’re 40 to have their first real job.

A final note: judging from the history of science, many future remedies for ALS, cancer, etc., will not come from the Senate trying to give a top-down mandate to an NIH director.

Instead, cures will often be found by someone randomly deciding to take soil samples from Easter Island, or to sequence an obscure archaebacteria, or to try to transplant a tumor from one chicken to another, or any number of research projects that at the time didn’t seem relevant to human health. NIH’s commitment to truly basic science wasn’t mentioned today, as far as I could tell, but in the end might be as important (or more so) than anything else.